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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A few of my healthcare social media friends were talking about why there was no #HIT100 this year and suggested that in true social media fashion someone should pick it up and run with it and I was nominated. I’m always happy to run with a good idea. Especially when @ShimCodeoffered to take care of the hard work. We also wanted to respect that we didn’t start the #HIT100 and so we created our modified version called the #HIT99. In open source we’d call that a fork of the original project. Hopefully we can still have the same spirit of fun and healthcare social media discovery that was embodied by the original #HIT100 (See last year’s unofficial list).

The first #HIT100 was started by @theEHRGuy as a great way to celebrate the Fourth of July holiday and turned out to be a fun way to get to know many of the various healthcare social media influencers throughout the summer. This summer we hope we can do the same with the #HIT99.

If you missed past versions, the #HIT99 is a way for you to recognize your peers, friends, and heroes who have been contributing to the #HealthIT, #HITsm, #hcsm, #HITchicks, #hcldr, and other related communities through their tweets, blogs, books, etc. Your nomination is a small reward for their efforts and all of the nominations in aggregate make for an amazing list of people working to improve healthcare. Plus, we’re looking at having a great #HIT99 celebration/meetup at 2016 HIMSS in Las Vegas as well.

In order to make the nominations more meaningful, we ask that all nominations include the person being nominated, the #HIT99 hashtag, and a short phrase or hashtag identifying why you’re nominating that person. Explaining “Why” is not required, but you’ll receive bonus points from the person you’re nominating and the rest of the community for doing so.

Here’s an example nomination: “I nominate @HITConfGuy to the #HIT99 list, because he makes it easy for me to filter through the mass of tweets during HIMSS.”

We’ll be using the following rules for counting nominations:
1. Twitter accounts must have existed prior to today.
2. The nomination process is completely socially biased, but we’ll filter obvious abuse where reasonable (Did the Chilean Princess with no followers really nominate you?).
3. RTs will be counted if they include the required elements.
4. Thank you RTs by the person being nominated will not be counted, but we do encourage sincere gratitude being expressed to those who nominate you. If you remove the nomination from your tweet you’ll have more room to show thanks without cluttering the stream.
5. There will only be one round of voting.
6. Please do not include the #HITsm or other hashtags unless they apply to the person(s) being nominated. Let’s be conscious of unnecessarily adding tweets to everyone’s stream.
7. Nominations will be counted at the sole discretion of the hosts (This is for fun anyway, so don’t stress it.)
8. Last but not least, you must have lots of fun!

I’m looking forward to seeing all the nominations and the final list of 99 healthcare social media influencers. Plus, I can’t wait for all the tweets joking that they’re part of the 99.

Legal Disclaimer: By submitting a nomination, you agree that any statements are your own opinion otherwise you would not have written or tweeted the message. All statements, whether funny or not, are your own information and thoughts. Funny tweets add no weight to your vote, but if you make us laugh we’ll love you for it. All other generic disclaimers apply, we just couldn’t take up any more words to state them.
Thanks @Matt_R_Fisher

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

#HITsm T1: How do you WANT to communicate with your healthcare provider? How does it differ from what’s available?

T1: When communicating with my provider, I want to get just the information I need without superfluous materials, in a timely fashion #HITsm

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: The ONC wants public comment on its #healthIT patient safety action plan. What oversight is needed to improve patient safety?

T1: I think #healthIT safety features in software should be standard, not pricey upgrades or optional to install. Safety always #HITsm

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

<Mandi’s Rant>

Few topics infuriate me as much as the notion that national standards-based implementation and adoption of healthcare IT should be cheap and easy. Haven’t we all heard the adage, “You can only have things done two of three ways: fast, cheap, or well”? Considering that the “thing” we’re trying to do is revolutionize the healthcare industry, the effects of which may be felt in each and every one of our lives at some point, don’t you want to include “well” as the bare minimum of what is required? After all, this is YOUR electronic health record, YOUR data, YOUR treatment plan and effectiveness measurements. So, what’s the other way we want this “thing” done: fast or cheap?

17 years is an entire generation of doctors. Doogie Howser could have been born, graduated med school, and begun to practice medicince by the time any insights from his birth were applied to practice. Suffice it to say, “fast” is not a way that healthcare is used to doing a “thing”.

Let’s contrast that with the information technology industry’s acceptance of iterative development releases and planned obsolescence for enterprise AND consumer assets. The big boys (Oracle, IBM, etc.) generally cease support of older products between 7-10 years after their introduction. Your company’s AS/400 server hardware may be 15 years old, but the O/S is the latest release, and all the data on the legacy server is preserved with the latest in backup packages over a wire-speed network connection. How long have you had your laptop? How frequently have you updated your Facebook app this year?

If someone tried to sell you a 17 year-old 480DX PC with a 9600 baud modem, 5″ floppy disk, 64MB RAM, running Windows 3.11 using the argument that, although much newer, faster, cheaper, more effective technology is available it is not yet PROVEN, would you buy it?

So, healthcare – an industry which moves at the speed of 17 years of Doogie Howser medical student maturity, and technology – an industry reinvented with the introduction of the iPhone in June of 2007, are at a crossroads for how to accomplish this “thing”: developing, implementing, and widely adopting national standards-based healthcare IT within mandated timelines that fall well within the next 10 years.

It must be done “fast”, relative to the usual pace of healthcare change.

And it must be done “well”, because it is OUR health at stake.

Suffice it to say, it will not be “cheap”. And my momma always told me that nothing worth doing is easy.

We have to stop whining about how costly and hard it is to turn this ship, and start working with the ONC on how to make healthcare IT better, faster, and ultimately more meaningful to all stakeholders involved in its use.

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Much hullaballoo is made over the 47% increase in Medicare payments from 2006-2010, which some seem eager to attribute to the adoption of EMR. The outcry is understandable; a 47% increase is a big dang deal, and taxpayers should be concerned. But haven’t we all heard that statistics lie?

“Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms,” cited the New York Times based on analysis of Medicare data from American Hospital Directory. Indeed, billing codes have changed from 2006-2010, in accordance with the HCPCS (Health Care Procedure Coding System) reform of CPT (Current Procedural Terminology) application and inclusion guidelines, cited here: HCPCS Reform from CMS. Healthcare industry growth and care advances drove an increase from 50 – 300 new CPT code annual applications between 1994-2004, leading to sweeping change in the review and adoption process starting in 2005 – including elimination of market data requirements for drugs.

Think about that for a second. If Pharma no longer has to submit 6 months of marketing data prior to applying for an official billing code, how many new CPT codes – and resultant billing opportunities – do you think have been generated by drugs alone since that HCPCS process change adoption in 2005? Which leads me to my next correlating fact: the most significant Medicare Part D prescription drug provisions did not start until 2006.

Let’s put two and two together: Medicare Part D prescription drug coverage (2006) + change in HCPCS billing code request process to speed drugs to market adoption (2005) = significant increase in Medicare reimbursements. To use the NYT analyst language, “in part”, administration of those drugs occurs in an emergency room. And who might be in the ER on a regular basis? I’ll give you a hint: “I’ve fallen, and I can’t get up!”

Perhaps the most profound contributor to this Medicare reimbursement increase is a recent dramatic rise in the Medicare-eligible population. Per the National Institute on Aging’s 65+ in the United States: 2005, the 65+ population is expected to double in size between 2005 and 2030 – by which point, 20% of the US will be of eligible age. The over-85 age group, as of 2005, was the fastest-growing population segment. Elderly people who are prone to chronic conditions as well as acute care events just might lead to higher Medicare reimbursements.

Of course, there are myriad contributing factors. Some industry analysts attribute the rise in Medicare claims cost to fraud, citing that the workflow efficiencies that the EMR technology provide allow for easy skimming. Activities such as “cloning”, or copying and pasting procedures from one patient to the next with minimal keystrokes within the EMR software, might contribute to false claim filing for procedures that were never performed. While the nefarious practice of Medicare fraud long predates EMR, the opportunity to scale one’s fraudulent operations to statistically relevant proportions increases significantly with automation. And as my mother always told me, it only takes one bad apple to spoil the bushel.

But how many bad apples would it take to spoil a multi-billion dollar bushel to the tune of a 47% cost increase? According to the NYT article, “The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone,” and the increase in billing activity for each of those 1700 occurred post-EMR adoption. After all, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments…compared with a 32 percent rise in hospitals that have not received any government incentives.”

Wait, did that statistic just indicate a significant increase in Medicare reimbursements, across the board? So the differential between those providers who have received government incentives for EMR adoption, and those who have not, is 15%. The representative facilities and providers responded to the “aggressive billing” accusation by indicating that they had 1) more accurate billing mechanisms, 2) higher patient need for billable services. I’ll buy that. Sure, it’s likely that there is Medicare fraud happening, but that’s not new – it’s unfortunate that there will always be ways to game the system, whether manual or electronic. But is the increase in “fraud” pre and post-EMR adoption statistically relevant?

Considering the complex variables involved, I’ll chalk up the 15% increase to the combination of more specific billing practices, Medicare Part D drug provisions, an aging population and the health issues which accompany it, and not vilify the technology which facilitates further advances. Let the EMR adoption expansion continue!

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